Abstract
PurposeA range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate.Design/methodology/approachThe evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes.FindingsIn total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links at all levels; create learning environments; organize shared responsibility; adjust financial strategies to market contexts; organize mutual gains; and align regional agreements with national policies and regulations. Contextual factors such as shared savings influenced the effectiveness of the guiding principles. Mechanisms by which these guiding principles operate were, for instance, fostering trust and creating a shared sense of the problem.Practical implicationsThe guiding principles highlight how collaboration can be stimulated to improve pharmaceutical care while taking into account local constraints and possibilities. The interdependency of these principles necessitates effectuating them together in order to realize the best possible improvements and outcomes.Originality/valueThis is the first study using a realist approach to understand the guiding principles underlying collaboration to improve pharmaceutical care.
Highlights
In order to provide high quality care while keeping health care systems affordable and accessible, many countries are moving toward a population-based approach
Enabling (+) or constraining (−) contextual factors that Mechanisms by which these guiding principles influence the likelihood of guiding principles to be effective operate
Engage a small number of stakeholders within + Prior mono-disciplinary approaches with little effect on Induces a sense of urgency to work together to achieve the care domain improving pharmaceutical care improvements on pharmaceutical care
Summary
In order to provide high quality care while keeping health care systems affordable and accessible, many countries are moving toward a population-based approach. The pioneer sites are monitored and evaluated by the Dutch Monitor of Pioneer sites Population Management of the Dutch National Institute for Public Health and the Environment (Struijs et al, 2015). These initiatives, serving over 2 million people, represent partnerships between health care insurance companies, primary care groups, hospitals, municipalities and community-based organizations, including regional patient organizations. All initiatives aim to improve health and provide better care at lower costs for the regional population by bridging clinical and community services ( Drewes et al, 2016). The pioneer sites started in 2013 with both care-related and pre-conditional interventions such as the organization of a governance structure for, for example, the development of a shared agenda and coordination of activities and communication
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